Medical school is 4
years with 3-4 years
of Internship and
Residency. There is
no
shortcut....Period!.

Steve Edelman, MSN/FNP-BC

12/23/13

There are physician
groups who respect
NP's and PA's as
peers and partners
but AAFP is not one
of them. I
discovered this when
I tried to obtain
CME through their
group online. I
received a pleasant
door slam. I was
told that joining
their organization
as a 2nd class
member (only option)
would not allow me
to obtain CME
through them that
was otherwise
offered as free. I
went elsewhere and
obtained it but was
left with a bad
taste in my mouth
that I cannot seem
to wash away. This
screwy survey simply
reinforces it..

Justin Hamlin, DO

12/23/13

Newsflash to midlevels: You ARE inferior.
You aren't medically trained. That goes
double for NPs. The whole concept of
midlevels is an end run around the
meaningful Flexner reforms, in order to
pursue a fool's errand of pinching pennies
on medical expertise by dumbing down the
practitioner acuity. As Non-Kool-Aid
Drinker MD points out, YOU did not go to
medical school. YOU did not go to
residency. I spend an inordinate amount of
time in patient care, both inpatient and
outpatient, fixing the dumb things that
midlevels do. Sometimes, often, the damage
is too much and cannot be completely
reversed. And now NPs want to pretend to
be doctors AND represent themselves as
such by calling themselves DNPs. And PAs
want to do the same by retconning
physician assistant into physician
associate. Even our petulant child in
chief has gotten into the act by
ignorantly appointing a nurse to be
Surgeon General of the Army. Want to be a
doctor? GO TO MEDICAL SCHOOL!.

Justin Hamlin, DO

12/23/13

Someone else wrote this, but it
brilliantly shows the absurdity of the
rationalization for midlevels:
My neighbors and I have plenty of guns.
Studies, promulgated by us and published
in our own journals, show we can protect
our locale just as well as the police--
albeit for six months only, and only for
relatively minor crimes, like string
spraying someone's driveway. We have
plenty of experience on the front lines of
the community. Oh, and people like us
better: we dish out their parking tickets
with a smile and a high five.
So, why shouldn't we be able to form our
own independent neighborhood patrol (NP)
service? We don't need to be regulated by
the police, since obviously we have a
different, um---je ne sais quois---and we
can set up our own credentialing and
certification services. Unlike the months
of police academy, we can also train new
NPs overnight; just fund our guns and
ammunition. There is a shortage of
policemen in our area, so this would
naturally solve all our crime issues while
simultaneously lowering costs and the
like.
We will be sure to wear proper police
uniforms and appropriate regalia, so the
public won’t be able to perceive any
difference in the quality of law
enforcement. We also should be rightfully
paid the same as conventional policemen,
since beginning in 2015, our overnight
training course will be extended to two
nights, culminating in the Deputy Chief
degree. NPs are the future of law
enforcement. If things get out of hand,
we’ll call up the National Guard..

shiikis

12/23/13

Well, truth be said, as a PA of 30 yrs, I've had countless pt's
tell me they'd rather have a PA working with them than an MD.
Why? comparable knowledge, sometimes more experience, but here's
the kicker... PA's have placed a value on the human condition, the
bed side manner. This quality is obviously a casualty of the
medical school selection process. Think about it, the MD's are
selected from a driven bunch of folks that have always valued and
received joy from the process of learning and problem solving, to
the exclusion of interaction/participation in life's activities
involving the human condition. Then all of a sudden, these med
school grads inter the real world and realize... They've got to
interact with the entire human, of which they've, for the most
part, had little interest. Voila! They see little value in the
human condition. C'est la vie!.

Stephen Sorsby, MD, MHA, FAAFP

12/23/13

I, too, am disappointed with the fact that the AAFP, my academy,
chose to ask this question, and to publicize it as it has been
publicized. I trained PAs in the Army, I introduced NPs to a rural
county. My patients in that rural county--and they all remained my
patients--loved their "doctor-nurse" (many never quite understood
the concept!)--not least because having two NPs tripled my reach
and meant that they had a primary care practitioner in their town,
where they could reach her, when they needed a PCP. Having NPs let
me practice where I should, at the upper reaches of my ability.
And, what shouldn't need saying: I've worked with PAs and NPs more
skilled than some physicians. We would be better served to find
ways for all medical personnel to do what they are trained and
capable of doing, and to stop all medical personnel from doing what
they are not capable of, regardless of their purported
qualifications..

Michele Roberts MD PhD

12/23/13

I believe that MD's
actually learned
something in medical
school and residency
that those who did
not go through this
rigorous training
did not learn. As a
patient, I recently
had bitter
experience with PA's
who couldn't admit
that they DID NOT
KNOW the answers to
my questions, so
they just made stuff
up. Being an MD
myself, I saw
through the
subterfuge, but they
were too ignorant to
understand why I was
unhappy. Truly the
hamburger-helper of
medical practice,
these two fake
doctors are an
embarrassment to the
institution where
they work. I do
believe that PA's
have an important
function to perform,
but the ones I was
unfortunate enough
to encounter didn't
get the memo. PA's
aren't MD's, and
they don't think
like MD's. Years
ago, I when I was a
pathology resident I
had a run-in with a
PA technician who
habitually missed
chorioamnionitis in
the discolored
placentas he grossed
in as "normal". When
my (accurate)
microscopic
diagnosis of "severe
chorioamnionitis"
(neutrophils don't
lie) didn't match
his description of
"unremarkable", he
argued that he had
seen hundreds more
placentas than I had
seen. True, he had
SEEN many placentas,
but he didn't know
what he was looking
at, and didn't
recognize pathology
when he saw it. PA's
are not doctors..

CNM (doctorally prepared)

12/23/13

What virulent posts,
Justin H! You must
really be feeling
threatened. Your
argument, however,
is fallacious, since
CNMs, and also NPs
if I've followed
their research
correctly, have
outcomes at least
equal to, and often
better than,
physicians for
patients of
equivalent risk.
This includes
patients with risk
factors. Clearly the
idea of any team of
which you're not in
control, including
control over
financial
reimbursement, is
outside your ability
to cope. This type
of team, however is
the future of health
care because we need
all qualified hands
on deck, not just a
self-appointed,
well-heeled coterie.
Yes, you've done a
wonderful job since
the Flexner report
of improving the
image of medicine.
You haven't proven,
however, that you
provide better care.
And, BTW,
"midlevels" is an
insulting title and
begs the question of
whom you would call
"lowlevels"? You
might update to
"advanced practice
clinicians" instead,
if you have any
interest in not
alienating your
colleagues..

A. Hominid

12/23/13

Dear Dr. Hamlin and Dr. Non-Kool-Aid Drinker: You have lost the war. The train has left the station.
That bird has flown. Family physicians have many years of training but it does not translate into
better primary care. In my opinion family practice physicians are basically obsolete and are being
replaced by mid-levels. I used to believe that physicians, with all of their extensive training, should be
caring for the most complex patients, leaving the routine care to mid-levels. However, my thinking
has changed. I work in a clinic staffed by 10 clinicians: 9 PAs/FNPs and one physician who only works
every other weekend. Two of the midlevels see primary care patients by appointment. These are not
routine visits. The patients are highly complex with multiple problems. When further evaluation is
required or the problem is not typically handled in our clinic (e.g., chronic pain management), the
patient is referred to a specialist. I am certain this strategy is used by most clinics employing
midlevels. The generalist physician is by-passed. In addition, one of our PAs is so competent and
skilled that one could put an MD behind his name and no one would know the difference. I attribute
this to his having taught in a major medical school for a number of years. He is more skilled than any
physician I have worked with in the past 32 years. I am impressed with the level of care provided and I
am very difficult to impress..

Dave Mittman, PA, DFAAPA

12/23/13

Jason: Tell us where you are working and at what level?
Let's all put our elbows on the table.
Dave.

noemotion-just facts

12/24/13

The survey is a simple accounting of public opinions on how they
view various providers in our health care system and, among those,
who they would prefer provide care to themselves and their
families. The survey is not designed to place less emphasis on team
-based care or to belittle the important contributions of non-
physician providers to patients and our health care system. What
the survey does show is that consumers clearly recognize that
physicians have a higher level of education and training and the
consumers equate this to a higher level of competency in care
delivery. They also clearly see value in team-based care and want
all providers to work together to provide the best care possible to
themselves and their family members. The emotional response to
this survey is predictable and sad. For years there has been a
desire to declare the primary care physician obsolete and coronate
non-physicians as the heirs to this throne. What the survey shows
is that the public actually doesn't agree with this and
wants/prefers a physician be involved and lead their health care
team. Simply saying something often enough or loud enough does not
make it true or accepted as this survey clearly demonstrates.
Finally, emotion has no room in these discussions. It is not a
personal attack on any individual, their education and training, or
their abilities to perform their task. We do not make public
policy based on our experiences with one individual, we make policy
on a set of facts that support some degree of expected outcomes..

Just another Pharm.D. , MPH

12/25/13

Unfortunately, all 4
of my interactions
with a PA, as a
patient, have been
negative. My wife's
allergic dermatitis
was diagnosed as
scabies, and
medicated as such.
Even I could tell
that was incorrect,
and forced her to
see a dermatologist
for the correct
diagnosis. The worst
pharyngitis of my
life was diagnosed
by a PA as herpes.
He insisted that I
must have had an
outbreak of herpes
labialis very
recently. I assured
him I did not, nor
have I every had
herpes of any nature
(later confirmed by
lab). Recently, my
cardiologist was
busy with an
emergency, and I saw
his PA. She insisted
that I start
immediately on high
dose folic acid. I
reminded her that
studies have shown
the non-efficacy of
high dose folic
acid. Then her next
recommendation was
niacin. That is when
I got up and walked
out. After my
complaint, as well
as that of other
patients with
knowledge of their
disease, she was
dismissed. But boy,
did all of these PAs
have attitude..

steve hammer, np

12/25/13

Dr. Hamlin, Dr. Kool-Aid, of course newly minted physicians with 3-
4 years residency experience, right out of the gate are better
prepared to care for patients. However, an NP or PA with suitable
practice experience, within their scope of practice eventually
performs equal care as evidenced by myriad surveys which apparently
you and your ilk prefer to ignore. My PA colleague David Mittman
in response to This AAFP survey said the following, &quot;To ask the
question AAFP did would be the same as asking a person with chest
pain if they would like to see a cardiologist or a emergency
medicine physician, Mittman said. Of course, people will pick the
cardiologist, but that doesn’t make the emergency doctor
unqualified.&quot; Well said David..

Paula Havisto, PA-C

01/11/14

I think Michele Roberts, MD, PhD has the PA technician mixed up with a Physician Assistant. A PA
technician is a Pathology Assistant, not a Physician Assistant..

This survey is a poll of those who choose to participate and are, therefore, not valid statistical samples, but rather a snapshot of what your colleagues are thinking.

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